title: Phase I trial of weekly cisplatin, irinotecan and paclitaxel in patients with advanced gastrointestinal cancer.
abstract: OBJECTIVE
  To determine the maximum tolerated dose (MTD), toxicities, and suitable dose for weekly 1-h paclitaxel combined with weekly cisplatin and irinotecan to treat advanced gastrointestinal malignancies.
  
  
  METHODS
  Thirty patients with metastatic or locally advanced (unresectable or recurrent) gastrointestinal solid tumors were enrolled on this single-center, phase I study. Patients were treated with paclitaxel given over 1h at 1 of 4 dose levels (40, 50, 65, or 80 mg/m(2)). Paclitaxel was followed by fixed doses of cisplatin (30 mg/m(2)) and irinotecan (50 mg/m(2)). All treatment was administered sequentially, once a week, in 6-week cycles (4 weeks on, 2 weeks off). Dose-limiting toxicity (DLT) was defined as a 2-week delay in treatment for grade 3 or 4 non-hematologic toxicity, neutropenic fever, a 1-week delay for grade 4 hematologic toxicity, or a 2-week delay for grade 3 hematologic toxicity.
  
  
  RESULTS
  Thirty patients were recruited; 28 patients were assessable for safety. Most of the patients (70%) had no prior chemotherapy. The primary first-cycle DLTs were neutropenia, diarrhea, and nausea. Paclitaxel at 65 mg/m(2) was defined as the MTD. The most common grade 3-4 toxicities observed during all cycles were neutropenia (57%), febrile neutropenia (11%), diarrhea (29%), fatigue (29%), and nausea (18%). No patients had G-CSF (Neupogen, Amgen Inc., Thousand Oaks, CA) support. Responses were observed in gastric, esophageal, and pancreatic cancers.
  
  
  CONCLUSIONS
  Paclitaxel at 65 mg/m(2), cisplatin (30 mg/m(2)), and irinotecan (50 mg/m(2)) given weekly can be safely administered to patients with solid tumor malignancies. To improve cumulative toxicities, a schedule modification was required (3-week cycle; 2-on, 1-off) Neutropenia was the most common DLT. This combination showed substantial activity, particularly in patients with gastric and esophageal adenocarcinoma, and phase II evaluation could be considered.
authors.affiliation: Gynecologic Medical Oncology, Medical Oncology Division, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA. teww@mskcc.org
authors.forename: William P
authors.initials: WP
authors.lastname: Tew
authors.forename: Delia
authors.initials: D
authors.lastname: Radovich
authors.forename: Eileen
authors.initials: E
authors.lastname: O'Reilly
authors.forename: Gary
authors.initials: G
authors.lastname: Schwartz
authors.forename: Deborah
authors.initials: D
authors.lastname: Schrag
authors.forename: Leonard B
authors.initials: LB
authors.lastname: Saltz
authors.forename: David P
authors.initials: DP
authors.lastname: Kelsen
authors.forename: Stacey
authors.initials: S
authors.lastname: Kepler
authors.forename: David H
authors.initials: DH
authors.lastname: Ilson
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D002166:Camptothecin / Q000008:administration & dosage / Q000031:analogs & derivatives; D002945:Cisplatin / Q000008:administration & dosage; D004305:Dose-Response Relationship, Drug; D005260:Female; D005770:Gastrointestinal Neoplasms / Q000188:drug therapy*; D006801:Humans; D000077146:Irinotecan; D008297:Male; D020714:Maximum Tolerated Dose; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009503:Neutropenia / Q000139:chemically induced; D017239:Paclitaxel / Q000008:administration & dosage
chemical_list: D000077146:Irinotecan; D017239:Paclitaxel; D002945:Cisplatin; D002166:Camptothecin